20 coding auditor educator jobs found

Opportunities At Change Healthcare Opportunities at Change Healthcare, part of the Optum family of businesses. We are transforming the health care system through innovative technology and analytics. Find opportunities to make a difference in a variety of career areas as we all play a role in accelerating health care transformation. Help us deliver cutting-edge solutions for patients, hospitals and insurance companies, resulting in healthier communities. Use your talents to improve the health outcomes of millions of people and discover the meaning behind: Caring. Connecting. Growing Together. Job Description: The experienced multi-specialty surgery coder is responsible for daily coding, denial management, charge hold, RAI resolution and abstraction. The coder is responsible for escalation of coding questions and requests for coding guidance to the Coding Coordinator and/or Supervisor. Participate in internal QA audits and provide feedback in the compliance QA process. Hours:...

Coder Reimbursement Specialist - Hospital The Coding and Reimbursement Specialist, CCS is responsible for coding and abstracting thoroughly, clinical data from the medical record. This includes both inpatient, outpatient, commercial, Medicare, Medicaid, and Illinois Public Aid, plus any other payor types. This accurate and timely coding is essential for reimbursement to the hospital, according to the appropriately selected principal diagnosis, grouped to the DRG in accordance with rules and regulations and coding methodologies, resulting in reimbursement and billing compliances as set forth by the Office of Inspector General. Manages workload and assigns work to three inpatient and two outpatient coders and oversees the day to day workings of the coding/reimbursement area. Monitors various regulatory sources to keep HIM coding and other staff informed and trained on various coding rules, regulations and related issues. Works closely with patient financial services to resolve any...

Become a part of our caring community The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical Coding Auditor audits medical charts and records for compliance with federal coding regulations. provide a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements. Essential Functions You will verify and ensure the accuracy, completeness, specificity, and appropriateness of medical record documentation based on a patient's documented medical conditions You will confirm appropriate diagnosis and procedure code assignment, following all applicable coding guidelines You will use electronic tools (i.e., spreadsheets-web-based) that have been created based on the CMS-HCC model and established coding guidelines...

Job Details Job Location: Epworth - Webster - St. Louis, MO 63119 Position Type: Full Time Education Level: High School Travel Percentage: None Job Shift: Day Job Category: Accounting Epworth seeks an experienced Medical Billing Specialist to lead disciplined revenue cycle execution and bring billing functions in-house. This role will be responsible for accurate and timely claims submission, state and local government program invoicing, denial management, payment posting, billing process control, and continuous improvement in reimbursement performance, with particular emphasis on Medicaid, managed care, and state and local government‑funded program billing. This is a hands‑on role for an experienced professional who combines strong technical billing knowledge with rigorous process discipline and a focus on strengthening reimbursement performance and cash realization. Primary Responsibilities Manage day‑to‑day billing and revenue cycle execution for Medicaid, managed care...

Hiring Department University Physicians Job Description This position is a dual post linked to Job ID 59698 - MCS-C and the department will be hiring for two positions. Review complex clinical documentation and diagnostic results timely to accurately assign codes for diagnoses (ICD-10-CM), procedures (CPT), and applicable modifiers for services provided to assure maximum reimbursement and regulatory compliance. Assist in the audit of medical records to identify potential problems with coding and reimbursement, such as edits, denials, and appeal letters. Act as liaison between third-party payers and assigned departments to coordinate all aspects of professional coding. Provide assistance to faculty, residents, and department staff in standards of medical record documentation and coding. Assist in the presentation of training sessions for faculty, residents, and staff to inform them of changes made to Medicare billing, federal laws and regulations, and other specific standards...

The Chronicle Of Higher Education, Inc. is hiring a Medical Coding Specialist in Columbia Township, Missouri. This role entails reviewing clinical documentation for accurate coding, assisting in medical record audits, and serving as a liaison with third-party payers. The candidate must complete a coding certification program and may substitute one year of related experience. The position offers a competitive salary range of $20.58 - $32.49 hourly and is eligible for a comprehensive benefits package including medical, dental, and retirement plans. #J-18808-Ljbffr

Coder Reimbursement Specialist - Hospital Full‑time position. The Coding and Reimbursement Specialist (CCS) is responsible for coding and abstracting clinical data from the medical record, including inpatient, outpatient, commercial, Medicare, Medicaid, Illinois Public Aid, and all other payor types. Accurate and timely coding is essential for reimbursement to the hospital, according to the appropriately selected principal diagnosis and DRG in accordance with rules and regulations and coding methodologies, resulting in reimbursement and billing compliances as set forth by the Office of Inspector General. The CCS manages workload, assigns work to three inpatient and two outpatient coders, and oversees day‑to‑day operations of the coding/reimbursement area. The CCS monitors regulatory sources to keep HIM coding and other staff informed and trained on coding rules, regulations and related issues, works closely with patient financial services to resolve claim denials, assists in...

Become a part of our caring community The Senior Market Consultation / Partnership Professional (Nurse Medical Coder) supports Clinical Support Team (CST) initiatives by promoting accurate, compliant, and complete documentation and coding practices that enhance the quality and measurement of programs across risk adjustment. Work assignments involve moderately complex to complex issues where analysis of clinical documentation, coding accuracy, and risk adjustment data requires evaluation of multiple variable factors. Key Responsibilities Perform detailed medical record reviews to ensure accurate ICD-10-CM coding, risk adjustment capture, and alignment with CMS-HCC (e.g., V24/V28) models Validate diagnosis coding and ensure documentation meets compliance standards Identify and escalate coding trends and documentation gaps Serve as a coding subject matter expert supporting CST workflows, including PDV, chart review prioritization, and provider outreach...

Job Type Full-time Description PURPOSE STATEMENT The Certified Coder will play a key role in converting diagnoses and treatment procedures intoICD-10, CPT and HCPCS codes. The Coder will review and accurately code office and hospital procedures for reimbursement. ESSENTIAL FUNCTIONS Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications. Researches and analyzes data needs for reimbursement. Analyzes medical records and identifies documentation deficiencies. Serves as resource and subject matter expert to other coding staff. Reviews and verifies documentation supports diagnoses, procedures, and treatment results. Identifies diagnostic and procedural information. Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes. Assigns codes for reimbursements,...

Certified Professional Coder, Outpatient Billing Full Time Corporate 3 days ago Requisition ID: 4107 Salary Range: $27.00 To $35.00 Hourly Position Summary This role is responsible for ensuring accurate, compliant, and complete coding of professional outpatient encounters in a high-volume urgent care environment. This role reviews provider documentation, validates and corrects CPT® and ICD-10-CM code selection, queries providers for missing or unclear documentation, and ensures all claims meet CCI, payer, and outpatient coding requirements prior to billing. This role also plays a key role in supporting provider coding and documentation audits and manual coding activities required during system downtime or special operational needs. Key Responsibilities Documentation Review & Coding Validation Review clinical documentation to confirm all services rendered are documented completely and accurately prior to billing. Validate provider-selected CPT® and ICD-10-CM codes to...

Coder Reimbursement Specialist - Hospital The Coding and Reimbursement Specialist, CCS is responsible for coding and abstracting thoroughly, clinical data from the medical record. This includes both inpatient, outpatient, commercial, Medicare, Medicaid, and Illinois Public Aid, plus any other payor types. This accurate and timely coding is essential for reimbursement to the hospital, according to the appropriately selected principal diagnosis, grouped to the DRG in accordance with rules and regulations and coding methodologies, resulting in reimbursement and billing compliances as set forth by the Office of Inspector General. Manages workload and assigns work to three inpatient and two outpatient coders and oversees the day to day workings of the coding/reimbursement area. Monitors various regulatory sources to keep HIM coding and other staff informed and trained on various coding rules, regulations and related issues. Works closely with patient financial services to resolve any...

Become a part of our caring community The Inpatient Medical Coding Auditor - PPI Coding Disputes reporting to the Manager reviews the appropriate DRG and ICD-10-CM/ PCS coding assignments for accuracy within the coding disputes team from a variety of medical records. The Disputes Auditor - MSDRG Inpatient Coding on the Disputes Team consults and collaborates with coding professionals within and across departments to ensure high accountability of coding disputes outcomes for timeliness, compliance and quality. Will be an experienced medical coding auditor with in-depth experience in inpatient coding audits (MSDRG/APDRG) Ensures overall accuracy and compliance of coding disputes reviews by adhering to all appropriate coding guidelines and communicates disputes outcomes to providers in a professional and concise manner. Leverages advanced auditing expertise to make coding decisions based on standard industry guidelines and best practices Manages multiple...

COMPANY OVERVIEW Health Partners Management Group, Inc (HPMG) is a government contracting company in Poplar Bluff, Missouri. HPMG currently bidding on a contract with the Federal Government for several coding positions. You would be a W-2 employee for HPMG and NOT a government employee. SUMMARY Responsible for assignment of accurate ICD codes for diagnoses and procedures. Medical Severity - Diagnostic Related Group (MS-DRG) is automatically assigned by the grouper software for inpatient stays. Inpatient coders may also be responsible for the assignment of accurate ICD diagnoses, current procedural terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), modifiers, and quantities from medical record documentation (paper or electronic) for inpatient professional services (a.k.a., rounds or IBWA encounters). Trains and educates MTF staff on coding issues and plays a significant role in coding compliance activities. MANDATORY KNOWLEDGE AND SKILLS Position requires...

Datavant is seeking a Profee Auditing Specialist in Jefferson City, Missouri. This role involves conducting professional fee coding audits, providing education on coding standards, and ensuring compliance. Candidates must have over 5 years of experience in fee coding and be a Certified Professional Coder (CPC). Benefits include comprehensive training, healthcare, a 401(k), and paid time off. Join Datavant to contribute to transformative change in healthcare through accurate data solutions. #J-18808-Ljbffr

Alignment Health is a remote company focused on senior care. The Medical Risk Adjustment (MRA) Coding Auditor role supports departmental quality assessment audits of internal coding analysts and vendors to ensure accurate and complete data submission to CMS. General Duties / Responsibilities Supports regular quality assurance audits of the internal Coding Analyst Team to validate and confirm coding & abstracting quality (95% HCC accuracy), ensuring coding quality and performance improvement standards are maintained. Tracks and reports progress of QA audits performed on coding vendors to verify coding accuracy and quality of data submitted to AHP for CMS submission. Works with Risk Adjustment Management on any MRA data validation or coding audit to ensure completeness and coding accuracy of all CMS submissions; this may include data reconciliation, data flow integrity, UAT testing, review of high‑cost/low‑risk score members, retrospective chart reviews, or other related data...

A healthcare organization in Kansas City is seeking a Compliance & Coding Audit Specialist to safeguard accuracy, integrity, and regulatory compliance. The role involves conducting audits and providing education related to coding, billing, and clinical documentation practices. Candidates should have a high school diploma, relevant credentials, and a minimum of three years of coding experience. Strong communication and organizational skills are essential. The position is full-time with a standard work schedule from Monday to Friday. #J-18808-Ljbffr

At Houston Methodist, the Lead Outpatient Coder position is responsible for providing administrative support to the department while ensuring diagnostic and procedure codes are assigned accurately to outpatient encounters based on documentation within the electronic medical record and maintaining compliance with established rules and regulatory guidelines. This position serves as the liaison between management, staff and physicians for routine matters, resolving questions and issues. Duties may be varied and may include many of the following: organize work schedules, create work assignments, review timecards for accuracy, conduct quality assurance audits of staff performance, develop and implement quality improvement activities, train and mentor staff, provide feedback on staff performance and developmental needs, collect/analyze/report on data, prepare reports on performance and metrics, and other responsibilities of a similar nature and level. FLSA STATUS Non-exempt...

Job Details Job Location: Epworth - Webster - St. Louis, MO 63119 Position Type: Full Time Education Level: High School Travel Percentage: None Job Shift: Day Job Category: Accounting Epworth seeks an experienced Medical Billing Specialist to lead disciplined revenue cycle execution and bring billing functions in-house. This role will be responsible for accurate and timely claims submission, state and local government program invoicing, denial management, payment posting, billing process control, and continuous improvement in reimbursement performance, with particular emphasis on Medicaid, managed care, and state and local government‑funded program billing. This is a hands‑on role for an experienced professional who combines strong technical billing knowledge with rigorous process discipline and a focus on strengthening reimbursement performance and cash realization. Primary Responsibilities Manage day‑to‑day billing and revenue cycle execution for Medicaid, managed care...

POSITION TITLE: Compliance Auditor REPORTS TO: Director of Compliance CLASSIFICATION: Non-Exempt POSITION SUMMARY: The Compliance Auditor is responsible for developing and executing audit plans based on research and regulatory guidelines and conducting internal and external audits of departments and their policies. They review programs, records, and systems to ensure adherence to regulations and to support an effective compliance program that prevents illegal, unethical, or improper conduct at the health center. Additionally, they compile and present audit findings to department leadership, assist in implementing procedural changes to resolve compliance issues, and may be reassigned duties as needed for accommodation or staffing reasons. ESSENTIAL FUNCTIONS: The following information is considered the definition of essential functions, but does not restrict the tasks that may be assigned. The Compliance Auditor may be reassigned duties and responsibilities...

Join a dedicated healthcare team serving the heart of the Midwest region. This role is perfect for a detail-oriented medical coder who thrives in a remote work environment and values accuracy and compliance. General Summary The medical coder ensures accurate billing by assigning appropriate ICD-10-CM, CPT, and HCPCS Level II codes in accordance with American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) guidelines. This position involves insurance credentialing and educating providers and staff on coding and billing standards. Routine chart audits and timely documentation review are essential components of this role. Essential Duties and Responsibilities Assign ICD-10-CM, CPT, and HCPCS Level II codes to finalized medical documentation to create accurate medical claims. Abstract relevant data from patient records to determine appropriate claim modifiers. Communicate with providers to clarify unclear or incomplete documentation and...